Identifying the elements in the Australian health service management revolution

Abstract: Several commentators have noted the accelerating turbulence occurring in health care at the present time. Indisputably, hospitals in Australia are going through a significant period of transition. It is argued in this paper that the magnitude of these changes will result in those organisations that we call hospitals in the future only barely resembling their counterparts in the recent past. A description of the movement to reform health care policy provides the backdrop to this discussion. This discussion of public policy initiatives broadly informs the debate and allows the major thesis of the paper to be explicated: that there is a health service management revolution occurring and it is taking place principally at the hospital level. Evidence for this view can be discerned from an analysis of four areas — organisational structure, the quality movement, changes in the management of hospitals and patients, and alterations in the way hospitals are financed. Thus, the very process of the transformation as it unfolds can be glimpsed. This paper discusses the evidence in an attempt to explain the crucial factors underpinning the revolution.